Several studies have pointed out that rural populations suffer from poorer mentalhealth than their urban counterparts. For example, rural children have significantly higher rates of mentalhealth problems and are more likely to have behavioral problems than urban children (Lenardson, Ziller, Lambert, Race, & Yousefian, 2010). Also, specific mentalhealth issues such as depression, domestic violence, child abuse, substance abuse and suicide are commonly found among rural residents (Bushy, 1993; Cantrell, Valley-Gray, & Cash, 2012; Cellucci & Vik, 2001; Lenardson, Hartley, Gale, & Pearson, 2012). Unfortunately, the mentalhealth of rural residents is affected by the availability, accessibility and acceptability of rural mentalhealthservices (Human & Wasem, 1991). According to these authors, availability refers to the existence or not of mentalhealthservices and the personnel necessary to provide them. Accessibility refers to the individual person’s ability to access those services including costs, insurance, transportation, and so on. Acceptability refers to the extent to which services offered are adapted to local values, cultural norms, lifestyle, and so forth.
After adjustment, the number of outpatient contacts was positively associated with no formal education and not working, receiving welfare benefits. It is well known that patients receiving welfare benefits are heavy users of outpatient mentalhealthservices . The first reason for this is that the illness of these persons is more severe than those who are working. Another reason could be that welfare benefits need to be revised routinely according to information supplied by the psychiatrist. Yet another reason concerns the fact that persons who do not work have more free time to attend health ser- vices. The level of education can also play a role, and our results show that a lower educational attainment increases the risk of higher service use. This could be due to less tolerance or knowledge of the illness and to an increased need to seek help. Nevertheless, our results concerning level of education differ from those found by Pezzimenti et al.  and Cooper-Patrick et al. , where a high level of education was associated with greater use of ambulatory services.
The Emili Mira MentalHealth Care Centres, with more than 80 years of history to them, are in Santa Coloma de Gramenet and have a complete offer of mentalhealthservices which include all areas of care: outpatients, emergencies, hospital and social and health care. The transfer from Barcelona Regional Council to the Generalitat of Catalonia, which took place in February 2010, and the task of managing it carried out by CatSalut at the MAR Health Park means the recognition of the excellent positioning of the institution in the area of mentalhealth and particularly of the IAPS (now transformed into the Institute of Neuropsychiatry and Addictions), guaranteeing the integral care of the patient at the same time as the coordination of different health lines, teaching and research. This move has involved the incorporation of more than 300 professionals into the MAR Health Park and is a reference population for some 900,000 inhabitants of the coast of Barcelona, Barcelonès Nord and the Baix Maresme. Participation in the health facilities in the Sant Andreu Barracks In this new health area in Barcelona, consisting of 113,000 m2, a Primary Health Care Centre, mentalhealth care centres and a social health centre were installed. The construction was put out to tender by the Consortium of the Zona Franca, while the MAR Health Park will be responsible for managing the primary health care and social health care facilities.
Our study has some obvious limitations. The most impor- tant one is the small coverage of countries in some areas, such as Africa, where only few national psychiatric societies exist. Secondly, respondents were all psychiatrists, which may explain the high salience attributed to psychiatric treat- ment settings in increasing the coverage of mentalhealth care. What was noteworthy, however, was the equally em- phatic readiness to acknowledge the crucial role of users of mentalhealthservices and their families, and the important role of non-specialist providers (primary care doctors, non- medical health workers) in diagnosis, medication manage- ment and psychosocial support. To the extent to which these professional leaders represent or influence the opinions of their members, this suggests that task shifting and collabora- tive care is considered both practicable and desirable. This is an important finding in the context of observations that psy- chiatrists can, on occasions, represent an obstacle to reform in this direction (12). On the other hand, this is the first sys- tematic survey of the opinions of leading psychiatrists world- wide on strategies for reducing the treatment gap, supported by the largest professional body in global mentalhealth. We acknowledge the need to consult all relevant stakeholders in planning the scaling up of mentalhealthservices to meet the need and reduce the treatment gap, and see this survey as a critically important first step in ascertaining the position of psychiatrists, arguably one of the most influential stakehold- er communities in global mentalhealth.
All cases included in the program are derived from various community resources (primary health care, schools, emergency services, and inpatient units for acute patients) and assessed exhaustively by the team to define the treatment plan for each case. The treatment modalities offered by the EPP are: individual and group therapy, unifamiliar and multifamiliar psychotherapy, psychoeducation and pharmacotherapy in those cases where necessary. Furthermore, there is an intensive community support for those patients who have difficulties engaging with mentalhealthservices. During the EPP all patients are monitored through weekly visits with their psychiatrist, psychologist, social worker and/or nursing staff.
Between 30% and 50% of people with schizophrenia are capable of work but only between 10% and 20% are in employment (Marwaha and Johnson, 2004; Schneider, 1998). Although some are in managerial or senior official positions, most are in ‘elementary’ jobs, for example cleaning and labouring, or are in skilled trade occupations such as plumbing or metal work. The rate of employment in people with schizophrenia seems to have fallen from before 1990 when surveys reported that between 20% and 30% were in work. Several studies conducted at two time points seem to confirm this reduction (e.g. Rinaldi and Perkins, 2007). The reason for this is unknown but one factor might be a reduction in the number of sheltered employment schemes. For those who present to services for the first time, the likelihood of being in employment falls markedly over the subsequent year or two (Birchwood et al., 1992; Johnstone et al., 1986). For people with Schizophrenia, premorbid social and occupational history are associated with employment and some types of psychotic symptoms and the presence of negative symptoms are associated with unemployment. The desire to have a job is one of the best predictors of future employment (Marwaha and Jonhson, 2004).
In knowledge transfer literature, less attention had been paid to the existing differences between academics, political analyst and knowledge brokers in terms of roles, legitimacy and inputs in developing policy briefings. Indeed, policy briefings had traditionally been prepared by policy analysts. The evidence based paradigm has raised new concerns about who would analyze and synthesize research results. In Canada, “a knowledge broker (KB) is a popular knowledge translation and exchange (KT&E) strategy emerging in Canada to promote interaction between researchers and end users, as well as to develop capacity for evidence-informed decision making.” (Dobbins, Robeson et al. 2009) However, APB by health academics is a new concept (Carroll, Cooke et al. 2006). Health and health research is complex and diversified; thus, it is hard to propose a standard approach for research push. APB is an individual behavior that needs a cultural change among health academics. To improve the performance of APB among health academics the university has to make intrinsic efforts. For example, a new system of awards has to be developed to value and support KT&E activities. In terms of capacity building, health academics have to be supported to build an effective KT&E strategy (Pope, Mays et al. 2006). Since, it is not only important to disseminate but also to evaluate the usefulness, the utility and the impact of the APB (Field et al. 2012; Kurko et al. 2012; Lavis, Rottingen, et al. 2012). There is also a major challenge for low and middle income countries where there is a need for implementing effective structured policymaking processes, estab‐ lishing functional KT&E platforms and leveraging policymakers and researchers’ engagement in KT&E activities (Collender et al. 2012; El-Jardali et al. 2012; Uneke, Ezeoha, et al. 2012). We explored the perspective of researchers from medical schools through a cross-sectional survey, which allowed us to control for faculties and schools idiosyncrasies and for time. However this approach necessarily limits the generalizability of these results cross other university departments. Future research should attempt to test the model predicting APB across a larger number of departments, especially those who carry public health research, to enhance the external validity of the presented model. We speculate that disciplinary specificities in terms of predictors will be identified.
This strategy document for 2008–2013 follows the previous CCS for Jordan, which covered the period 2003–2007. Its formulation is the result of analysis of the health and development situation and of WHO’s current programme of activities. For its development, a national CCS team was formed representing officials from the Ministry of Health and High Health Council along with WHO staff from the country and regional offices and headquarters (Annex 1). During its preparation, key officials within the Ministry of Public Health and Population as well as officials from various other government authorities, United Nations agencies, nongovernmental organizations and private institutions were consulted. The critical challenges for health development were identified. Based on the health priorities of the country, a strategic agenda for WHO collaboration was developed. Clear guiding principles were used to identify the challenges as they relate to the context of Jordan, national and partnership frameworks, the prioritized areas of work and strategic directions.
La responsabilidad social aumenta cuando tratamos con seres humanos que, ya al nacer o posteriormente, sufren o padecen una enfermedad mental. Según el DSM-IV-TR “…los trastornos mentales son patrones o síndromes sicológicos o de conducta clínicamente significativos, que ocurren en individuos y que están asociados a un distrés presente (por ejemplo, síntoma doloroso) o discapacidad (por ejemplo, dificultades en una o más áreas de funcionamiento) o con un riesgo significativamente mayor de sufrir muerte, dolor, discapacidad o una importante pérdida de libertad. Además, este síndrome o patrón no debe ser meramente una respuesta esperada o sancionada culturalmente a un evento particular, por ejemplo, la muerte de un ser querido. Cualquiera que sea su causa original, debe considerarse en el presente como una disfunción conductual, sicológica o biológica en el individuo. Ni una conducta atípica (política, religiosa o sexual) ni conflictos principalmente entre el individuo y la socie- dad son trastornos mentales, a menos que lo atípico o el conflicto sean un síntoma de una disfunción en el individuo, según se ha descrito arriba”(2).
En Perú, la salud mental –conceptuada por psiquiatras como Honorio Delgado, con gran inﬂuencia del humanismo– contemplaba la importancia de los aspectos psicológicos y ambientales tanto en la génesis de las patologías como al momento del tratamiento. Sin embargo, esto no se veía reﬂejado en la práctica ni en las políticas de salud. Hace unos pocos años se ha puesto énfasis en la prevención de la enferme- dad y en la promoción de la salud, considerando la participación activa de la sociedad.
Una gran cantidad de literatura reporta hallazgos correlacionales de estudios realizados en países desarrollados donde el aborto es legal. Dichos estudios presentan graves problemas metodológicos y sesgos selectivos que exageran los riesgos de salud mental asociados con el aborto, mientras que minimizan los riesgos de la maternidad no deseada. Los profesionales de la salud deben ser capaces de evaluar críticamente esta literatura y tener cuidado al generalizar los hallaz- gos sobre el aborto provenientes de contextos diferentes en términos legales. Aspectos como las diversas características de las mujeres, y las circunstancias y razones para evitar un nacimiento, no se han in- corporado adecuadamente en la teoría o la investigación que busca explicar la variación en la salud mental tras un aborto.
unemployed population from good healthservices. The best availability of drugs on the market should mean a way to redistribute the access to this new technology and that a greater population benefited from this situation which would have repercussions on the reduction of inequities in health in Mexico. In this study when we compare the year 1998 just starting the generics market families spent approximately 11% of their income keeping this percentage to 2010 when this consolidated generics and similars market. However, in the last year the entry of cheaper medicines has produced a wealth effect because households can buy a greater number of medication and therefore it has a better access to them. Another aspect to mention is that in Mexico they have almost a universal coverage of healthservices wth the ‘Seguro Popular’ but this sure has not removed the expense in the population with low income. So the right that people have to achieve good health requires social arrangements that cover a bigger range than the health care distribution, where access to medication is not carried out according to the level of income of the population.
There were differences in DD mortality according to the health coverage status. Between 2000 and 2016, PWSS had an average annual mortality rate due to DD of 2.3 deaths per 100 000 population, compared with PWOSS, who had an average annual mortality rate of 4.5 deaths per 100 000 population (almost twice, 95%CI 1.90 – 1.97). However, the gap was closed, such that the risk of dying due to DD decreased from 2.6 (95%CI 2.4 – 2.7) in 2000 to 1.2 (95%CI 1.1 – 1.2) in 2016, comparing people with and without social security. Among PWOSS, DD mortality decreased rapidly until 2009, after which the rate has remained almost unchanged.
The historical expectation of psychiatry has been to translate clinical labels into natural entities in order to become a medical specialty relating etiol- ogy to anatomy or physiology. The reliance upon course, processes or developments instead of a real bodily lesion or phenomenon makes almost impossible to chart similarities and compare phe- nomena in different contexts. The connotation of global as integral but variable, rejecting homoge- neity, indicates that mentalhealth (encompassing different and relevant aspects of life for a given human being) is, and should be, quite diverse depending upon context, culture, and tradition. The “Umwelt” of a member of an African tribe is different from the environment of a suburban dweller in New York. And global (in the sense of embracing all aspects of embeddedness) has a different meaning for these two persons. Accord- ing to Kleinman(8), academic psychiatry, with its current emphasis on neuroscientific reductionism and dependence from pharmaceutical industry, should reorient itself to a wider social horizon in order not to become irrelevant. This is all the more evident considering the small numbers of specialists in LMICs and their concentration in urban areas, not to mention language barriers for research and experiences published in languages other than English. A paradigm change, as advo- cated by some(9), does not solve the main issue, which seems to be a more intense involvement of other professionals and lay people in the con- struction of mentalhealth, as a pursuit wider than the treatment of mental disorders.
La satisfacción de las necesidades psicológicas de los niños puede ayudar a fortalecer a las sociedades que enfrentan los efectos desestabilizadores de la pobreza, el conflicto armado, el hambre y las enfermedades infecciosas. La OMS ha declarado que la falta de buena salud mental en las primeras etapas de la vida puede llevar a trastornos mentales con consecuencias en el largo plazo, socavar el cumplimiento de las prácticas de salud generalmente aceptadas como buenas, y reducir la capacidad de las sociedades de ser seguras y productivas. Es fundamental que todos trabajemos juntos, los profesionales de la salud men- tal, los que abogan por la causa, las familias, y los encargados de formular políti- cas, a fin de mejorar la atención y el tratamiento de nuestros niños y adolescentes. En octubre del 2008, la OMS presentó el Programa de acción para superar las bre- chas en salud mental y mejorar y ampliar la atención de los trastornos mentales, neurológicos y por abuso de sustancias(12). El programa se basa en las mejores evidencias científicas disponibles y ofrece un conjunto de estrategias y activida- des para ampliar y mejorar la atención de las personas con trastornos mentales, neurológicos y por abuso de sustancias.
Medical practice nowadays is a rather complex process in which numerous languages (techno- logical, scientific, humanistic, philosophical, his- torical and ethical, among others) are spoken or written in the name of patient care, good health and its inherent quality of life component(1). Furthermore, the conceptual evolution of the field has seen the multiplication of terms, the accentuation of dichotomies and the inter-con- nection of areas of knowledge and research(2,3) that, ultimately, cannot avoid a political impact and the convergence of those avenues into the field of Public Health and its many branches. In turn, the international scenario of practice, en- hanced by the multifaceted phenomenon we call Globalization(4-6) has contributed to the coinage of terms such as Global Health (GH), defined as the area of study, research and practice that pla- ces a priority on improving healthservices and achieving equity in health for all people worldwi- de(7). Born in the 1970’s(8), GH aspired to be, from the beginning, not only a body of policies or a bureaucratic echo chamber: it attempted to become a “movement of ideas” beyond mere sta- tistics and graphs, engendering specific actions to be materialized by international agencies or foun- dations(9,10) if and when not by selfish financial or commercial interests behind and within the so- called developed world(11).
Although the current findings warrant attention, sever- al limitations must be noted. The number of participants re- ferred to the screening modules was surprisingly low. Fam- ily physicians were encouraged through clinical sessions and pamphlets to refer patients who were suspected to have depression and no additional work load was requested. The underestimation of depression may be explained by the stigma and prejudice of family physicians. In addition, the short duration of the consultation may have led patients to underreport emotional and mental symptoms that they at- tribute to physical health causes and assume are a normal consequence of aging. Also patients had no assessment of visual and auditory acuity. We recognize the importance of having obtained such sensory characteristics and thus be able to assess the level and capacity of reception and under- standing of cognitive behavioral strategy used.
I n light of the recent 50th anniversary of the Chilean National Health Service (NHS), the authors’ re- view of recent literature on health reforms suggests the utility of a commentary on the social roots of this im- portant phenomenon and on the profound changes that Chile began to undergo in the early 1950s. The authors represent two different points of view: Mardones, a direct participant at the start of the health reform pro- cess, was able to follow its evolution for four decades as a manager, teacher, and researcher; Azevedo, a pub- lic health researcher who lived in Chile as an interna- tional consultant on healthservices development from 1993 to 1999, had the advantage of a first-hand, yet ex- ternally-oriented, view. It is hoped that the combina- tion of these two perspectives will contribute to a discussion of this exciting process and the measures necessary to assure its future. In sum, the challenge is to evaluate the development of the Chilean health sys- tem since 1952 under the conceptual framework pro- posed by Cavanaugh. 1
Despite the limitations, evaluations of the collaborative process indicate that it has been enriching for all those involved, in large part due to the engagement of motivated and committed local leaders with the unfolding process [35, 36, 38, 39]. The first comprehensive evaluation revealed that participants’ engagement stemmed from the importance they attached to gaining technical skills to better assist clients, such as motivational interviewing and brief interventions for addictions . The 2008 evaluation indicated that participants’ engagement remained strong as they perceived significant changes in their own attitudes toward clients, allowing them to use a more client-centred approach , in how they addressed stigma, and in how they integrated both health promotion and self-care—all valuable and novel approaches to their practice and essential reasons for remaining involved . However, it is important that future evaluations focus on longitudinal impact in order to better demonstrate the outcomes of the collaboration.